Jiaxing University Master's Degree Cultivation Base, Zhejiang Chinese Medical University, Jiaxing, China.
Department of Rheumatology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
Front Immunol. 2024 Oct 3;15:1459241. doi: 10.3389/fimmu.2024.1459241. eCollection 2024.
Systemic lupus erythematosus (SLE) is a complex autoimmune disease, and despite the availability of multiple treatments, striking a balance between long-term efficacy and side effects remains a major clinical challenge. B-cell-directed therapy has attracted much attention because of its unique mechanism of action. Belimumab and obinutuzumab, as representative drugs for B-cell-directed therapy, have shown their respective advantages for SLE treatment. However, data on combination therapy with obinutuzumab and belimumab are currently unavailable.
We present the severe case report of a patient who was diagnosed with lupus nephritis (LN) with gastrointestinal involvement and developed acute renal failure. The patient responded to the first dose of obinutuzumab but failed to achieve a complete response to LN. The repeated use of obinutuzumab was limited by persistently low IgG levels and frequent infections. This is a real-world challenge that must be addressed. Therefore, the patient was subsequently treated with a novel sequential regimen of obinutuzumab followed by belimumab. After 18 months of follow-up, the patient achieved a complete clinical response with a favourable safety profile, along with the conversion of all autoantibodies from positive to negative and sustained negativity. To date, the patient has achieved a dual clinical and serological response.
There is a reason to believe that this novel combination regimen could be developed as a therapeutic strategy, with the expectation of balancing efficacy and safety.
系统性红斑狼疮（SLE）是一种复杂的自身免疫性疾病，尽管有多种治疗方法，但在长期疗效和副作用之间取得平衡仍然是一个主要的临床挑战。B 细胞靶向治疗因其独特的作用机制而备受关注。贝鲁单抗和奥滨尤妥珠单抗作为 B 细胞靶向治疗的代表性药物，在 SLE 治疗方面各自显示出了优势。然而，目前尚无关于奥滨尤妥珠单抗和贝鲁单抗联合治疗的数据。
我们报告了一例狼疮肾炎（LN）合并胃肠道受累并发生急性肾衰竭的重症患者。该患者对奥滨尤妥珠单抗的首剂治疗有反应，但对 LN 未达到完全缓解。由于持续低 IgG 水平和频繁感染，重复使用奥滨尤妥珠单抗受到限制。这是一个必须解决的现实世界的挑战。因此，该患者随后接受了奥滨尤妥珠单抗联合贝鲁单抗的新型序贯治疗方案。在 18 个月的随访中，患者达到了完全的临床缓解，且安全性良好，同时所有自身抗体从阳性转为阴性并持续阴性。迄今为止，患者实现了双重临床和血清学反应。
有理由相信，这种新的联合治疗方案可以作为一种治疗策略，有望在疗效和安全性之间取得平衡。
